offered by

Public Employee Retirement Administration Commission

related to

Public Retirement Benefits

PERAC General Membership Forms

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Table of Contents

Member Benefit Forms

Authorization to Use or Disclose Protected Health Information (PDF 15.63 KB)

Beneficiary Change Form (PDF 60.32 KB)

Beneficiary Selection Form (PDF 93.17 KB)

Disability Application Glossary of Terms (PDF 126.97 KB)

Disability Retiree Earned Income Worksheet (PDF 540.47 KB)

Disability Retirement Application Form (PDF 322.17 KB)

Disability Retirement Benefits for Veterans (PDF 104.73 KB)

Instructions for Submitting the Annual Statement of Earned Income (PDF 58.68 KB)

Lump Sum Distributions: Special Tax Notice (PDF 59.38 KB)

Memorandum #17 Attachment 1 (PDF 58.03 KB)

New Member Enrollment Form (PDF 132.85 KB)

Pre-Tax Rollover Form (PDF 71.28 KB)

Refund Application (PDF 217.06 KB)

Retirement Application (voluntary superannuation) (PDF 209.38 KB)

Retirement Option Selection Form (PDF 119.73 KB)

Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF 173.25 KB)

Veterans' Buyback Form (PDF 165.11 KB)

Survivor Benefit Forms

Application for Member Survivor Benefits (PDF 91.47 KB)

Notice of Election of Benefits under 12(2)(d) (PDF 105.32 KB)

Spousal Affidavit to Determine Benefit Eligibility (PDF 103.71 KB)